Delayed cord clamping

Delayed cord clamping is a birth practice where the umbilical cord is not clamped or cut until after pulsations have ceased, or until after the placenta is delivered. A growing number of parents are choosing delayed cord clamping for their baby.

The timing of clamping the umbilical cord, and practices have a sizeable impact on the outcomes or mother and baby. Research has shown that when we delay cord clamping the neonate will receive up to 30% more of the fetal-placental blood volume than it would have with immediate cord clamping.

When your baby is born, the cord and placenta system will contain about one third of your baby’s blood, whilst the remaining two thirds is in the baby.

Benefits

The benefits of delayed cord clamping for the baby include a normal, healthy blood volume for the transition to life outside the womb; and a full count of red blood cells, stem cells and immune cells. For the mother, delayed clamping keeps the mother-baby unit intact and can prevent complications with delivering the placenta.

The placenta

Before birth, the baby and placenta share a circulating blood supply that is separate to the mother’s. Inside the uterus, the placenta and umbilical cord provides the baby with oxygen, nutrients and clears waste. During fetal life, the baby’s organs only need a small flow of blood while the placenta performs the role of lungs, kidneys, gut and liver for the baby. This is why a significant portion of the baby’s total blood volume is in the placenta at any given time. The blood circulating the placenta and cord is not ‘extra’ blood or waste – it belongs to the baby.

Immediately after birth, the cord pulsates as the placenta continues to provide essential oxygen and nutrients, and begins to deliver blood back to the baby. This transfer of blood is called placental transfusionand it is a vital part of the birth process.

Placental transfusion is the system that provides the baby with red blood cells, stem cells, immune cells and blood volume. Delayed cord clamping allows time for the placental transfusion, ensuring safe oxygen levels and blood volume in the baby.

The World Health Organisation states the “optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 minutes or more after birth).”

Risks of immediate cord clamping

For many decades, various studies have shown that immediate or early cord clamping disrupts normal physiology, anatomy and the birth process – it severs the baby from the still-functioning placenta and halts the circulation of blood.

Large studies have shown that immediate cord clamping can result in lower iron stores in the baby for up to 6 months after birth. While not all the implications of a reduced iron status are understood, iron deficiency in the first few months of life is associated with neurodevelopmental delay, which may be irreversible.

Early cord clamping can cause complications for the mother, too. There is some evidence that early clamping increases the risk of post-partum hemorrhage and retained placenta by engorging the placenta with the baby’s blood. This makes it harder for the uterus to contract and expel the placenta.

Risk of delayed cord clamping

Small studies have shown that delaying cord clamping increases the risk of jaundice. A study found that 3% of babies who experienced early cord clamping, compared to 5% of babies who experienced delayed cord clamping required treatment for jaundice.

In summary

Delayed cord clamping leaves the cord alone after birth and avoids disrupting the normal birth process. While the cord is pulsating, placental transfusion is supplying the baby with oxygen, nutrients and an increased blood volume to support the transition to life outside the womb.

Delayed cord clamping confers many benefits to the newborn baby including higher number of red blood cells, stem cells and immune cells at birth. In premature or compromised babies, delayed cord clamping may provide essential life support, restore blood volume and protect against organ damage, brain injury and death. »

This is the recommendations from the ACOG website :

The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice makes the following recommendations regarding the timing of umbilical cord clamping after birth:

In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.

Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.

There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.

Delayed umbilical cord clamping does not increase the risk of postpartum hemorrhage.